Headaches

Question 1

What are the red flags of headache?

Answer 1

SNOOP
S= systemic signs and disorders
N= neurologic symptoms
Indicate meningitis, HTN

O= onset new or changed and patient >50 years old
Space occupying lesion, glaucoma

O= onset in thunderclap presentation
Vascular (SAH)

P= papilloedema, pulsatile tinnitus, positional provocation, precipitated by exercise
Raised ICP

Question 2

What would indicate a space occupying lesion?

Answer 2

Gradual onset, progressive 
Associated neurology eg: visual disturbance or focal sign 
Features of increased ICP 
- early morning headache 
- N+V 
- worse on coughing or bending

Question 3

What is the presentation of a migraine?

Answer 3

Unilateral often front!
Sudden onset or gradual p, throbbing or LH,saying
Between 4 and 72 hours long and can be. T Leic
Photo/ photophobia
+/- aura, N and V
Triggers- food, sleep, stress
Often FHx

Question 4

How does a tension type headache present?

Answer 4

Band like over forehead

Question 5

What are the aggregating factors of a tension headache?

Answer 5

Stress
Poor posture
Lack of sleep

Question 6

What is a medication overuse headache?

Answer 6

Headache lasting at least 15 days per month doesn’t improve after OTC medication

Caused by regular overuse greater than 3 months of- triptans or opioids at least ten days of the month and regular overuse greater than 3 months of- paracetemol, NSAIDS, aspirin at least 15 days of the month

Question 7

How long does it take for an overuse headache to resolve?

Answer 7

Takes 2 months since stopping medication

Question 8

What drugs can give you headaches?

Answer 8

Anti anginals and anti hypertensives

Question 9

.what is the management,ent of a migraine?

Answer 9

Avoid triggers
Prophylaxis with propranolol or topiramate

Manage an acute attack with sumatriptan in addition to paracetemol or an NSAID
Ensure patients are not taking their combined oral contraceptive pill as it increases their risk of ischaemic stroke